Dialysis providers, administrators, and dialysis patient advocacy groups in the renal community have expressed concern over the cuts to the ESRD bundle outlined in a proposed rule the Centers for Medicare & Medicaid Services issued July 1.

More changes have occurred in the End-Stage Renal Disease Program in the last three years than perhaps its 30-year history. Certainly, technology has advanced over the last four decades. Consolidation in the 1990s and early 2000s took out many of the smaller players, or the bigger dialysis providers who didn’t have a good management team. But the way that Medicare payment policy for the dialysis provider community has changed — and the way it will continue to evolve through the end of this decade — will be significant.